Senior Operations Eligibility Analyst

Southern Scripts - Atlanta, GA

Full-time - Mid Level

Remote - Atlanta, GA

Ambulatory Health Care Services

About the position

The Senior Operations Eligibility Analyst is responsible for overseeing and coordinating the processing of eligibility files between Liviniti's internal systems and external partners. This role requires a deep understanding of eligibility file formats, systems integration, and troubleshooting issues related to data exchanges. The analyst will ensure that eligibility files are processed accurately and timely, while continuously improving processes to enhance operational efficiency.

Responsibilities

• Manage the end-to-end process of eligibility file transfers between Liviniti and external partners.
• Collaborate with cross-functional teams to ensure seamless integration and data mapping of eligibility files.
• Analyze and resolve eligibility file-related discrepancies, errors, and data integrity issues.
• Maintain strong relationships with external vendors, clients, and partners to ensure timely and accurate data exchange.
• Develop and document eligibility file specifications, transmission protocols, and data requirements.
• Coordinate with internal teams to configure eligibility feeds for new and existing vendors.
• Lead eligibility file testing, validation, and implementation with partners and internal teams.
• Ensure adherence to Liviniti's privacy and security standards regarding eligibility data.
• Maintain thorough knowledge of file types, including 834, fixed width, delimited, and proprietary formats, ensuring proper mapping, transformation, and integration.
• Monitor ongoing performance and proactively resolve issues related to eligibility file processing.
• Provide mentorship and guidance to junior team members or specialists, as necessary.

Requirements

• Bachelor's degree in business, Information Systems, or a related field.
• Minimum of 3-5 years of experience in eligibility management, operations, or a similar field.
• Experience working with file formats such as 834, XML, or other eligibility data formats.
• Experience working with SQL.
• Proven experience with data mapping and troubleshooting file transmission issues.
• Familiarity with data validation and transformation logic.
• Knowledge of PBM claims adjudication processes is a plus.
• Advanced proficiency in Excel, including the use of formulas and data validation tools.
• Experience in project management or process improvement is preferred.

Nice-to-haves

• Expertise in eligibility file formats, data mapping, and system integrations.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Excellent communication skills, both written and verbal, to interact with external partners and internal teams.
• Ability to work independently while maintaining strong collaboration with cross-functional teams.
• Familiarity with HIPAA and other regulations about data privacy and security.
• Ability to adapt and thrive in a dynamic, growth-oriented company culture.

Benefits

• Medical, Dental, Vision insurance
• Disability and Life insurance
• Employee Assistance Program
• Remote work options
• Generous Paid-Time off
• Annual Reviews and Development Plans
• Retirement Plan with company match immediately 100% vested